This report addresses the critical issue of maintaining large, old trees in United States forests that historically experienced frequent fires but have been subjected to long periods of fire suppression. The document synthesizes existing research to understand how reintroducing fire through prescribed burning impacts these venerable trees, particularly concerning injury and mortality. It delves into the causes of tree death from fire, including heat damage to crowns, cambium, and roots, with a specific focus on the role of accumulated duff and subsequent bark beetle attacks. Furthermore, the report examines management options and treatment effects aimed at enhancing old tree resilience during prescribed burns, offering practical guidance on techniques like duff raking and burning under specific conditions, ultimately striving to balance ecological restoration with the conservation of these keystone forest components.